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Great Lakes Article:

Antibiotic Water Pollution May Be Part of E.Coli Problem

This is a 3-part series printed by Iowa's Des Moines Register

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Some link bacterial peril
to antibiotics put in feed

By PERRY BEEMAN
Des Moines Register
Register Staff Writer

08/04/2002

Critics of feeding antibiotics to healthy livestock often blame the
widespread practice for the existence of drug-resistant bacteria in rivers,
streams and lakes.

Antibiotics are added to feed for hogs, cattle and chickens, even in doses too small to kill germs, because farmers have found they make the animals grow faster. Manure from such livestock is spread on fields as fertilizer.

Many of the livestock antibiotics are available over the counter and are
administered by farmers, in some cases with the guidance of a veterinarian.

Dr. David Wallinga, who follows this issue for the Twin Cities-based
Institute for Agriculture and Trade Policy, said the fact that farmers can
buy drugs anytime they want and give them to animals, unsupervised and at will, is outrageous. "It doesn't pass the laugh test," he said.

The United States has little usable data about antibiotic use. The Union of Concerned Scientists estimates that eight times as much antibiotics are used on livestock as on humans. However, that group notes that human use is a bigger threat, because of the number and size of doses involved and because of regular contact among people at hospitals, nursing homes and child-care centers.

The Animal Health Institute, representing makers of drugs for veterinary
use, calls for more research but contends that livestock don't contribute
as much to the problem as some critics insist.

"Antibiotic resistance is a significant human health threat, but it has
nothing to do with animals," said Ron Phillips, spokesman for the
institute. He said some federal data suggest that the number of foodborne illnesses is declining, which is disputed by opposing groups.

The European Union and some individual countries such as Sweden and
Denmark have moved to end the use of the most effective human antibiotics on animals that aren't sick. That idea hasn't caught on in the United States, but the cries for action are becoming louder and more widespread.

The American Medical Association, the Union of Concerned Scientists, the Institute for Agriculture and Trade Policy and the Alliance for the Prudent Use of Antibiotics have called for limits.

U.S. Sen. Edward Kennedy, D-Mass., and other senators have introduced federal legislation aimed at reducing the use of such drugs on healthy livestock. That bill has drawn the support of the American Public Health Association, the American College of Preventive Medicine and the Ambulatory Pediatrics Association.

The National Academy of Sciences estimates that such livestock bans would cost consumers $5 to $10 each a year in higher meat prices.

Scientists such as Steve Dritz of Kansas State University are challenging
decades of hog-raising practices with studies that suggest healthy hogs
don't benefit from antibiotics in their feed except when they are very
young. Dritz and his colleagues found that newer hog-raising methods - such as separating hogs that are at different stages of growth - cut the risk of bacteria spreading and eliminate the need to feed the animals antibiotics when they aren't sick.

The American Veterinary Medical Association has called for better education for veterinarians and farmers on how best to use antibiotics.

That's not enough, said Wallinga.

"Education is great, but the crisis of antibiotic resistance has reached
the level that we can't rely on an unenforceable mechanism to limit these
uses."

State-lake tests detect 'superbugs'

E. coli bacteria able to withstand antibiotics are found at four sites, which poses some threat to swimmers
By PERRY BEEMAN
Des Moines Register
Register Staff Writer

08/04/2002

Potentially dangerous E. coli bacteria capable of fighting off common
antibiotics are present in some state-park swimming areas, a study of water there shows.

Results of water-testing by the Des Moines Sunday Register are the first
indication - although a small one - that so-called superbugs are spreading to Iowa's recreational lakes.

Many doctors and scientists have warned for years that the overuse of
antibiotics in people and livestock will breed bacteria that have mutated
to resist the most common and successful of those drugs. People sick with illnesses that have been fairly easy to handle could find themselves sicker and harder to treat. Infections could last longer and force doctors to try several medicines to find one that works.

The prophesies have come true in the drug-rich confines of hospitals and
other areas.

"Antibiotic resistance has been called one of the world's most pressing
public health problems," say officials at the U.S. Centers for Disease
Control and Prevention. Their goal is to keep threats such as salmonella,
shigella and the dangerous strains of E. coli from getting out of control.

At risk is a decades-old arsenal of now-threatened drugs such as
tetracycline, penicillin, erythrymycin and fluoroquinolones, a class that
includes the high-powered, anthrax-fighting drug Cipro.

Studies have found antibiotic-resistant bacteria in lakes, rivers and
underground aquifers, said Dr. Mary Gilchrist, a microbiologist and
director of the University of Iowa Hygienic Laboratory. A recent University
of North Carolina study found them underground near livestock confinements. The U.S. Geological Survey found traces of antibiotics in Iowa streams, which Gilchrist said probably means bacteria that can fight antibiotics, also called antimicrobials, are there, too.

The potential for trouble in Iowa exists, researchers say. People are more likely to demand antibiotics from their doctors, even when their ailment is caused by a virus that can't be killed by drugs. And they sometimes eat poorly cooked meat containing dangerous bacteria that are resistant to medicines. Antibiotics and the bacteria that survive pass through people and into rivers through city sewage plants.

In rural areas, antibiotics are fed to livestock, even in doses too small
to kill germs, because farmers have found they make the animals grow
faster. Manure from such livestock is spread on fields as fertilizer.

The Register's water-sampling, which probably was the first systematic
check at state-park beaches, found antibiotic-resistant E. coli in the
swimming areas at:

* Pikes Point State Park, West Okoboji Lake.

* Lake Manawa State Park, Council Bluffs.

* Lake of Three Fires, Taylor County.

* Lake Darling, near Brighton in Washington County.

The presence of E. coli often means fecal matter has washed into the lake, possibly bringing disease-causing organisms with it. The murkiness of Iowa's lakes makes them more likely to harbor bacteria longer than most, Gilchrist said.

Waterborne illnesses commonly cause intestinal problems or infections of the skin, eyes or ears.

The threat to Iowa swimmers and other fun-seekers is small but serious,
said Dr. Patricia Winokur of the University of Iowa's College of Medicine,
who took part in the analysis of beach water.

Winokur said the Register's samples were too few to say a lot about the
threat to swimmers. She stressed that, in general, swimmers are unlikely to swallow an organism that will survive the body's natural defenses and make them sick, then will fight off antibiotics, too.

Even so, it pays to be careful, Gilchrist said. Anyone who has a suppressed immune system or is undergoing chemotherapy should think twice, she said.

"You wouldn't want to increase your risk by even a small percent by
swimming in a lake," Gilchrist said.

Here's how the Register's survey of lake water worked:

Scientists at the U of I's hygienic lab and Winokur analyzed samples
collected by a Register reporter from the 34 state-park swimming areas. The scientists found that water from nine of the parks had significant amounts of E. coli bacteria. They took random bacteria from those nine samples to test for resistance to 26 common antibiotics.

>From those nine came the four samples in which resistant E. coli were
found. The sample from Lake Manawa fought off five types of antibiotics.
Bacteria from the other three resisted tetracycline, which is considered a
very effective drug.

"That's impressive," Winokur said, and it opens the possibility that the
powerful bacteria have spread to some degree across the state.

Iowa authorities are doing little to study the problem in lakes. Several
state and federal scientists say they aren't aware of any comprehensive
study of antibiotic resistance in Iowa's lakes.

The Iowa Department of Natural Resources has no plans to begin systematic checks because it can't afford to, said Mary Skopec, who oversees the agency's water-monitoring efforts.

The department has struggled to fulfill its current responsibilities amid
budget cuts in recent years and a decades-long string of new demands from the governor and Legislature that came with no money to carry them out. In some cases, the department failed over more than two decades to do other monitoring work required by state law. Iowa law does not require the department to check for antibiotic resistance.

Skopec said she would propose at least limited checks for resistance in
state lakes beginning next year. The process can be expensive, she said, and may depend on whether the state can get federal grants.

The department already is working with the University of Iowa and the U.S. Geological Survey to check for resistance in rivers, as part of a
nationwide study led by Iowa City-based scientist Dana Kolpin.

These tests differed from those performed for the Register in that
scientists looked for the existence of the medicines themselves in the
river water, rather than for bacteria that had developed a resistance to
the medicines.

The medicines were found in small concentrations nationwide in areas most likely to be polluted by human and animal wastes, Kolpin said, although he declined to identify the Iowa locations affected. He said the data were still being confirmed.

Gilchrist, of the hygienic lab, said the small amounts of antibiotics found
in Iowa rivers would not be enough to kill the germs. Rather, the bacteria
are exposed to the drugs enough to mutate and breed into a resistant strain.

A separate study by Kolpin found that less than 20 percent of samples from 28 stream sites near 10 of Iowa's larger cities contained antibiotics.

Because many Iowa lakes get water from rivers, or are merely wide spots in the rivers themselves, it's likely the lakes have antibiotic-resistant bacteria, the DNR's Skopec said.

"Our lakes are extensions of the streams," Skopec said.

How great is threat? Experts disagree

By PERRY BEEMAN
Des Moines Register
Register Staff Writer

08/04/2002

Most health officials and scientists agree that overuse of antibiotics will
lead to potentially stronger germs that will be more difficult to treat.
They differ on the seriousness of resistant bacteria found in the
environment, such as swimming water.

Undercooked meat and germs from toilet accidents are a bigger threat to people's health, said Dr. Patricia Quinlisk, Iowa's state epidemiologist.
The doses patients receive at doctors' offices and hospitals make the
"infinitesimal" amounts found in the environment virtually meaningless, she said.

She wants doctors to cut the amount of unneeded antibiotic prescriptions by some counts as much as 50 percent of all doses - before the state should worry about so-called superbugs found in the environment.

Already, she said, doctors are being more stingy. The number of cases of antibiotic-resistant pneumococcal bacteria, which can cause pneumonia, ear infections and other illnesses, has dropped slightly the past few years. In children under 5, the number has dropped by half, probably because of a new vaccine, Quinlisk said.

Even so, other scientists still are concerned about the germs as an
environmental problem.

Dr. David Wallinga, who follows this issue for the Twin Cities-based
Institute for Agriculture and Trade Policy, said resistant bacteria almost
certainly have spread widely across Iowa's manure-washed lakes.

"The resistance seems pretty widespread in the environment because
antibiotic residues are persistent in the environment," he said.

The problem, he said, is not so much people becoming infected with bacteria now, but rather carrying a bacterium that could pass its resistance on to another bacterium.

David Ropeik of the Harvard Center for Risk Analysis agrees in his
soon-to-be-published book, "Risk," that resistance can easily spread from innocuous germs to disease-causing organisms.

And in the June 2002 issue of Environmental Health Perspectives, a science journal, Abigail Saylers brings the issue home. "Evidence is mounting that your intestinal tract is a swinging singles' bar for bacteria," writes Saylers, a microbiology professor at the University of Illinois and
president of the American Society for Microbiology. "And it's
all-inclusive. We're talking about gene transfer across genus and species
lines. That's like a human impregnating a slug."

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